How Does Initial Surgery Age Affect the Radiological Results of Single-Stage Open Reduction, Femoral Shortening, and Salter’s Osteotomy in Patients Over the Age of Four With Developmental Hip Dysplasia ?

Abstract

OBJECTIVE: One of the most controversial issues in pediatric orthopedics is Developmental dysplasia of the hip (DDH). The timing of diagnosis and treatment are is the main goal to treat this condition successfully. Neglected cases that may remain undiagnosed until advancing age are still seen especially in developing countries. Delayed diagnosis and treatment with advancing age leads to more extensive surgery and cause low satisfactory rates. The aim of this study is to evaluate the effect of patients’ age on the results of single-stage treatment of Developmental Dysplasia of the Hip.MATERIAL AND METHODS: 23 patients (34 hips) treated in our hospital between 2004 and 2010 were included in the study. Single-stage treatment including open reduction, femoral shortening, and Salter’s innominate osteotomy was applied to patients whose mean age of surgery was 7.5 years. Radiological results were evaluated in terms of improvement in the acetabular index, in the acetabular angle and according to Severin’s classification, and Bucholz and Ogden’s avascular necrosis (AVN) classification at the final follow-up.RESULTS: The average follow-up period was 60 (range: 24 - 84) months. While the acetabular index was 39.7°±1.4° (range: 25°- 52°) preoperatively, it was measured as 21.8°±1.8° postoperatively. The mean amount of improvement in the acetabular angle was 17.9°±0.8°. According to Bucholz and Ogden’s classification, one patient (2.9%) had Type 1 AVN and one patient (2.9%) had Type 3 AVN. Radiologically, the success rate (85.7%) was significantly higher in children aged 8 years and younger (p = 0.008).CONCLUSIONS: According to the improvement in the acetabular index and Severin's radiological classification, successful results are obtained after a single-step treatment of DDH, which is treated in the 4-8 age range. However, the radiological results of children older than 8 years are worse than those under 8 years old.